Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “EMBOLISM”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed1994

Predictors of myocardial infarction after distal embolization of coronary vessels with percutaneous transluminal coronary angioplasty. Experience of 21 consecutive patients with distal embolization.

Of 1,855 patients with angina pectoris who underwent percutaneous transluminal coronary angioplasty (PTCA) in our hospital, 21 experienced distal embolization. Five of the patients had slow washout of contrast medium distal to the dilated stenosis accompanied by S-T segment elevation (slow-flow pattern). In the other 16 cases, a dislodged embolus was found distal to the dilated stenosis (occlusive pattern) following balloon inflation. Of the 21 patients, 8 (38%) developed acute myocardial infarction (MI). All patients with acute MI were thought to have intraluminal thrombus on angiography performed before PTCA. Interestingly, patients with recent MI or worsening angina had a significantly higher rate of acute MI (p < 0.05).

Adult↗
PubMed2000

Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism.

In patients with chronic obstructive pulmonary disease (COPD), differentiating a pulmonary embolism (PE) from an exacerbation of COPD can be difficult, since clinical signs and symptoms of the two conditions overlap. Development of reliable noninvasive or minimally invasive techniques for the diagnosis of PE is, especially in these patients, necessary. In this study we assessed the effect of COPD on the accuracy of the clinical probability estimate (CPE), spiral computed tomographic angiography (SCTA), D-dimer analysis, ventilation perfusion (V/Q) scintigraphy, and pulmonary angiography for the diagnosis of PE. From May 1997 through March 1998, 627 consecutive patients with suspected PE were investigated in six teaching hospitals. In these patients, D-dimer testing, CPE, V/Q scintigraphy, and SCTA and/or pulmonary angiography were performed according to a strict diagnostic protocol. The patients were also independently categorized as having COPD or not. A diagnosis of COPD was established in 91 patients (15%). The prevalence of PE was similar in patients with and without COPD (29% and 31%, respectively), notwithstanding the larger proportion of nondiagnostic V/Q scan results in patients with COPD (46% versus 21%, p < 0.001). The distribution of CPEs, diagnostic value of the D-dimer assay and SCTA, and reproducibility of pulmonary angiography were comparable among patients with and without COPD. The presence of COPD does not affect the diagnostic performance of CPE, D-dimer testing, SCTA, or pulmonary angiography. Furthermore, although more nondiagnostic V/Q scan results can be expected in the presence of COPD, V/Q scintigraphy remains a valuable screening test in patients with COPD.

Acute Disease↗
PubMed1994

Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis. An international multicenter randomized trial. The Bolus Alteplase Pulmonary Embolism Group.

STUDY OBJECTIVE: To test the hypothesis that a reduced dose of bolus recombinant human tissue-type plasminogen activator (rt-PA) (0.6 mg/kg/15 min, maximum of 50 mg) would result in fewer bleeding complications than standard 100 mg of rt-PA administered as a continuous infusion over 2 h among hemodynamically stable patients with pulmonary embolism (PE). Subsidiary objectives were to compare the two rt-PA regimens with respect to the following: (1) the rate of other adverse clinical events; (2) the magnitude of change from baseline on perfusion lung scans, pulmonary angiograms, or echocardiograms; and (3) the differences in coagulation parameters over time. DESIGN: A double-blind, double-dummy, randomized, controlled trial. SETTING: Twenty-eight participating hospitals in the United States, Italy, and Canada. PATIENTS: Patients could be included if they had symptoms or signs of PE within 14 days of presentation as well as high-probability lung scans and/or pulmonary angiograms demonstrating PE. INTERVENTIONS: Randomization was undertaken with a 2:1 allocation ratio to rt-PA 0.6 mg/kg/15 min (maximum of 50 mg) or to 100 mg/2 h. Ninety patients were randomized, and 87 patients were treated: 60 with bolus rt-PA and 27 with 2-h rt-PA. All patients underwent baseline and 20- to 28-h follow-up perfusion lung scintigraphy. Patients at angiogram centers underwent baseline and 2-h follow-up angiography, while patients at echocardiogram centers underwent baseline, 3-h, and 20- to 28-h echocardiography. Forty-eight patients also participated in an ancillary study of serial fibrinogen and fibrin degradation product levels. RESULTS: In the first 14 days after randomization, there were six deaths: five (8.3 percent) in the bolus group vs one death (3.7 percent) in the 2-h group (p = 0.66). There were two clinically suspected nonfatal recurrent PEs during the first 14 days after therapy, one in each treatment group. Overall, 14 patients suffered major or other important bleeding: 8 in the bolus group and 6 in the 2-h group (p = 0.35). Changes in efficacy parameters (scans, angiograms, or echocardiograms) were similar in the two treatment groups. After initiation of therapy, patients who had received bolus rt-PA had less depression of fibrinogen levels (p = 0.007) and smaller increases in fibrinogen degradation products (p = 0.013) than patients who had received 100 mg of rt-PA over 2 h. CONCLUSIONS: No significant differences were detected between the bolus rt-PA and 2-h rt-PA with respect to bleeding complications, adverse clinical events, or imaging studies. There was less fibrinogenolysis with the bolus dosing regimen.

Adult↗
PubMed2000

Embolization of spinal cord arteriovenous malformations with an ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx liquid embolic system). Report of two cases.

In this paper the authors describe the first use of a new liquid embolic agent (Onyx) to treat spinal cord arteriovenous malformations (AVMs). Because its properties make it more predictable to use than currently available liquid agents, the authors believe that this material has great potential in the endovascular management of both spinal cord and brain AVMs. This very promising agent merits further clinical study.

Adolescent↗
PubMed2001

[Fatal pulmonary embolism developing after tympanoplasty: a case report and incidence of pulmonary embolism at Toyooka Hospital].

We report a case of fatal pulmonary embolism (PE) developing after tympanoplasty. A 69-year-old woman underwent type III tympanoplasty for a middle ear cholesteatoma under general anesthesia. Operating time was 3 hours 27 minutes and anesthesia lasted 5 hours 9 minutes. The next morning, 14 hours 5 minutes after returning to the recovery room, the patient lost consciousness while getting out of bed. Although consciousness recovered transiently, she went into shock with cardiopulmonary arrest. Heart beat was regained after resuscitation with artificial respiration and cardiac massage, but her blood pressure was unstable. Echocardiography revealed right ventricular overload and pulmonary hypertension. Because PE was suspected, thrombolytic therapy was conducted to stabilize hemodynamics. Enhanced computed tomography (CT) of the chest showed bilateral pulmonary thromboembolism. The patient died of hypoxic encephalopathy 23 days after PE onset. We have seen 40 cases of PE at our hospital in the last 70 months. Five patients developed PE after surgery with a postoperative occurrence rate of 0.03% (5/16, 277), and 3 of them died. Enhanced CT in 19 of 21 cases (90.5%) before or just after the start of therapy for PE was useful in establishing the diagnosis. Although PE is rare in the field of otolaryngology and head and neck surgery, it may develop rapidly after any type of surgery resulting in a fatal outcome. It is thus important to establish diagnosis early and prevent such serious complications.

Aged↗
PubMed2005

[Cholesterol embolism of the upper urinary tract as a clinical feature of atherosclerotic embolic vascular disease. Report of three cases, one of them simulating neoplasia].

OBJECTIVES: To report three cases of atherosclerotic embolic vascular disease with clinical presentation in the lower urinary tract. This disease is not frequent; it mainly affects the skin, kidneys and skeletal muscle. Other organs of the urinary tract are rarely affected and they are exceptionally the clinical site of debut without previous known involvement of other areas. METHODS/RESULTS: The first patient presented with hematuria associated with an ultrasound/cystoscopical image suspicion for neoplasia. Pathologic report of the transurethral resection chips showed polypoid cystitis with some small size arteries occupied by cholesterol needles, associated with inflammation, ulcers and hematic extravasation. The second patient underwent cystoprostatectomy for a transitional cell carcinoma and, incidentally, numerous cholesterol emboli were found, mainly in the lamina propria, but also in other layers of the bladder wall, prostate, urethra, veru montanum, and one seminal vesicle; this two latter sites have not being reported in previous publications. The third patient showed the embolus within a prostate biopsy core. CONCLUSIONS: This unfrequent disease may present as a bladder or prostatic process and be diagnosed by biopsy of these organs. It may simulate a bladder neoplasia on ultrasound or cystoscopy and should be included among related or etiologic entities of polypoid cystitis, a well-known simulator of neoplasia.

Aged↗
PubMed2000

[Impending paradoxical embolism visualized by echocardiography combined with pulmonary embolism: a case report].

A 43-year-old man was admitted to our hospital complaining of dyspnea on exertion and dizziness. Transthoracic echocardiography revealed a mobile mass (3.5 x 1.0 cm) attached to the left atrial septum and transesophageal echocardiography showed the mass in the right atrium protruding through the patent foramen ovale into the left atrium. A mobile snake-like thrombus was apparent in the right atrium and right ventricle. The diagnosis was pulmonary embolism with impending paradoxical emboli.

Adult↗
PubMed2001

Acute pulmonary embolism: impact of selection bias in prospective diagnostic studies. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism.

We evaluated selection bias in a prospective study of 1,162 consecutive patients with suspected pulmonary embolism. Of these, 983 were eligible, and 627 could actually be included. During two months extensive data were collected on all non-included patients. Finally, our patient characteristics were compared with those of the PIOPED study (1990) and the study of Hull et al. (1994). Compared with included patients, the non-included patients had more often non-diagnostic V/Q scans (50% vs. 36%, p <0.01) and were more often already hospitalized (31% vs. 22%, P = 0.04). The subgroup of patients not included due to refusal or inability to give informed consent (IC) was older (mean age 61 vs. 53 years, P <0.01), more often suffered from malignancies (26% vs. 11%, P <0.01) and frequently had non-diagnostic V/Q scans (57%) as compared to included patients. In our study, 54% of all patients screened was eventually included versus 27% in the PIOPED study. In the PIOPED study patients who had contra-indications for pulmonary angiography were excluded, while in the study of Hull et al. those with inadequate cardiorespiratory reserve were excluded. In studies on new diagnostic technologies, patient selection bias does occur. The potential for such a selection bias should be taken into account when diagnostic strategies are devised to improve their generalizability and acceptability.

Adult↗
PubMed2005

A critical appraisal of non-invasive diagnosis and exclusion of deep vein thrombosis and pulmonary embolism in outpatients with suspected deep vein thrombosis or pulmonary embolism: how many tests do we need?

The requirement for a safe diagnostic strategy should be based on an overall posttest incidence of venous thromboembolism of less than 1% during 3 month follow-up. Compression ultrasonography (CUS) has a negative predictive value (NPV) of 97% to 98% indicating the need of repeated CUS testing. Serial CUS testing is safe but you have to repeat 100 CUS to find 1 or 2 CUS positive for deep vein thrombosis (DVT), which is not cost-effective indicating the need to improve the diagnostic work-up of DVT by the use of clinical score assessment and D-dimer testing. The combination of a less sensitive D-dimer test (SimpliRed) and low clinical score does not, whereas the combination of a sensitive D-dimer test (ELISA VIDAS or Tinaquant) and low clinical score does safely exclude DVT without the need of CUS. The combination of a first negative CUS and a negative less sensitive D-dimer test (SimpliRed) or a sensitive ELISA D-dimer at a higher cut off level of 1,000 ng/ml safely excludes DVT with a NPV of > 99% without the need to repeated CUS in about 60%. The sequential use of a sensitive D-dimer and clinical score assessment will safely reduce the need for CUS testing by 40% to 60%. Large prospective outcome studies demonstrate that one negative examination with complete duplex color ultrasonography (CCUS) of the proximal and distal veins of the affected leg with suspected DVT is safe to withhold anticoagulant treatment with a NPV of 99.5%. This indicates that CCUS is equal or superior to serial CUS or the combined use of clinical score, D-dimer testing and CUS. Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but not for subsegmental PE. A normal perfusion lung scan and a normal rapid ELISA VIDAS D-dimer test safely exclude PE. Helical spiral CT detects all clinically relevant PE and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic ventilation perfusion scan (VP-scan) or a high probability VP-scan. Single-slice helical CT as the primary diagnostic test in patients with suspected PE in 5 retrospective studies and in 3 prospective management studies indicate that the NPV of a normal helical spiral CT, a negative CUS of the legs together with a low or intermediate pretest clinical probability is 99%. Helical spiral CT can replace both the VP-scan and pulmonary angiography to safely rule in and out PE. The combination of clinical assessment, a rapid ELISA VIDAS D-dimer followed by CUS will reduce the need for helical spiral CT by 40% to 50%.

Ambulatory Care↗
PubMed1979

[Basic studies on the pathogenesis and treatment of fat embolism. I. Fracture mechanism and fat embolism].

We examined the amount of fat that can be forced into the circulation by compression of femora and of heads of the tibia in the very moment of injury. By fractures of diaphyses no considerable reduction of the intraosseous space was achieved and no fat was expelled through the foramina nutritia before the hard cortical bone was splintered. However, considerable amounts of fat were expelled into veins, when the epiphyses of the femora or when the head of the tibia was compressed from medially and from laterally. Even by a purely manual compression some fat was forced to leave the spongiosa by the foramina nutritia. This is explained by the higher elasticity of the spongious bone, permitting a marked space reduction by compression even before a fracture sets in. The mechanism resembles the procedure of opacification of veins by contrast media, injected into the bone cavity under pressure. The significance of these findings for the pathogenesis of clinical fat embolism is discussed.

Adult↗
PubMed1984

[Multicenter study of 2 urokinase protocols in severe pulmonary embolism. Research Group on Urokinase and Pulmonary Embolism].

The results of a multicentre trial (10 centres) of urokinase (UK) extracted from human urine in patients with recent massive pulmonary embolism (PE) are reported. The aim of this trial was to compare the efficacy of two protocols of UK therapy: low dose UK: 2 000 IU/kg/hour (UKl) associated with heparin, against high dose UK: 4 400 IU/kg/hour for 12 hours (UKh) followed by heparin. This randomised single blind trial included patients under 80 years of age. The clinical diagnosis of recent PE (less than 5 days) was confirmed by pulmonary angiography showing over 30% vascular obstruction (Miller index greater than 11). The efficacy of treatment was assessed by the degree of early revascularisation on pulmonary angiography 30 to 48 hours after the start of thrombolytic therapy, as analysed by 4 independent vascular radiologists. A total of 133 patients entered the trial between November 1978 and October 1981: 2 died before receiving treatment, 2 were excluded, 129 patients were retained (67 UKl and 62 UKh). The initial clinical, haemodynamic and angiographic parameters were comparable in the two groups: Miller index; 22.6 +/- 3.7 (UKl) and 22.6 +/- 3.4 (UKh), an average vascularisation defect of 66%. The efficacy of treatment was the same: 26% and 20% respectively. The incidence of haemorrhagic complications was the same in both groups: 24% and 29% respectively, but only 2% of patients had spontaneous severe bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

[Embolization of the inferior mesenteric artery in hemorrhagic bladder neoplasms after failure of hypogastric arteries embolization].

The authors report 3 cases of revascularisation through the inferior mesenteric artery of bladder tumors which had previously been treated by transcatheter occlusion of both hypogastric arteries because hemorrhage. New uncomplicated embolizations of the inferior mesenteric artery are performed in 2 cases and recurrency of the bleeding was stopped.

Acrylic Resins↗
PubMed1994

[Optimal size of embolic material in transcatheter arterial embolization of the liver].

The purpose is to determine the optimal size of gelatin sponge, less toxic and more effective, in transcatheter arterial embolization (TAE) of the liver. In experimental study on toxicity, gelatin sponge particles (GSP) were divided by their size into four groups, 0-200 microns, 200-500 microns, 500-1000 microns and 1000-2000 microns. In each group, three mongrel dogs underwent TAE. After a week, the livers were investigated pathologically, and the rate of liver necrosis was measured. The average rate was 23.7 percent with GSP of 0-500 microns, while 0.5 percent with 500-2000 microns. Microscopically, coagulation necrosis was found in 6 of 6 dogs with 0-500 microns, while in 2 of 6 with 500-2000 microns and bile duct injury was found in 5 of 6 dogs with 0-500 microns, while none with 500-2000 microns. In clinical study on effectiveness, ten patients with hepatocellular carcinomas underwent TAE with GSP of 0-500 microns, 500-1000 microns and 1000-2000 microns respectively. After a week, the rate of tumor necrosis was measured by CT. The average rate was 94.8 percent with 0-500 microns, 93.5 percent with 500-1000 microns and 86.8 percent with 1000-2000 microns. These results suggest that the optimal size of GSP is 500-1000 microns.

Animals↗
PubMed1995

Lymphatic air embolism: a new hypothesis regarding the pathogenesis of neonatal systemic air embolism.

Objective. Neonatal systemic air embolism (NSAE) has been thought to result from introduction of air into the pulmonary veins through hypothesized alveolar-capillary fistula. The objective of this paper is to reassess the distribution of intravascular air visualized radiographically in this entity. Based on these data, an alternative theory for the pathogenesis of NSAE is proposed. Materials and methods. Four cases from our institutions and 21 additional reviewable published radiographs of NSAE were evaluated for the presence and location of intravascular air. Nonparametric statistical analysis was performed to determine if the predominance of intravascular air was venous or arterial in location, and to determine the presence or absence of pulmonary interstitial emphysema (PIE), pneumothorax, pneumomediastinum, and pneumopericardium. Results. Isolated systemic venous air was present significantly more often than isolated systemic arterial air (p < 0.0005). In addition, the presence of isolated right-sided cardiac air was found significantly more often than air within left heart chambers alone (p < 0.0005). PIE in patients with NSAE was found to be statistically more prevalent than pneumomediastinum or pneumopericardium, though similar in prevalence to pneumothorax. Conclusion. Our data support the hypothesis that intravascular air in NSAE is predominantly venous in location. PIE was found to be a very common associated finding in NSAE. Based on our current knowledge of pulmonary lymphatics, radiographic anatomy, and the lymphatic location of PIE, we propose that air within the pulmonary lymphatic system (PIE) gains access to the systemic venous system via lymphatic ducts, which results in the clinical entity NSAE. This readily explains the venous predominance of air in NSAE.

Embolism, Air↗
PubMed1997

[Histological effect of arterial embolization chemotherapy for metastatic liver tumors from colorectal cancer--report of cases of hepatectomy after arterial embolization chemotherapy].

To evaluate the histological effect of arterial embolization chemotherapy (AEC) for the metastatic liver tumors from colorectal cancer, 5 lesions were examined in 4 patients who were treated with surgery after AEC. In addition, to compare the histological changes of the metastatic liver tumors, we histologically examined 7 lesions in 5 patients who were treated with surgery alone as a historical control. For the patients with AEC, anti-cancer agents and lipiodol were administered by selected hepatic arterial infusion with fragments of sponzel. In a group of AEC, all metastatic liver tumors were detected after resection of the primary tumors. The range of tumor size in these lesions was from 2.5 to 4.2 cm in diameter. Otherwise, in a group of non-AEC, the size of tumors ranged from 2 to 5 cm in diameter. In angiography, tumor stainings were detected in 2 lesions, and in all lesions no accumulation of lipiodol was detected by CT scan. The overall response rate at the surgery was 7 to 33% (average 23%) in a group of AEC. In addition, in 2 lesions, about 60% of the lesions were necrotic tissues, and more than 90% of the tumor lesions in 3 lesions were histologically necrosis. Within these lesions, encapsulation of the metastatic tumors was observed in 3 lesions. Otherwise, in a group of non-AEC, 50-70% of the tumor lesions were histologically detected as necrosis, and in one lesion, encapsulation was observed. These evidences suggest the histological effect of AEC may be evaluated when more than 70% of tumor necrosis in lesions is observed. In conclusion, the treatment was effective in 3 cases and not effective in one case.

Adenocarcinoma↗